Hospice lifespan.
September 4, 2010 10:21 PM   Subscribe

Grandma has been with no food/no water for 3 days now. How long might she go on?

She is 97, weighs about 85 pounds. I'm at her bedside for the overnight shift. She had a major stroke, mostly can't talk, and cant move enough to write. So what's a reasonable window of time here?

Also, any advise for how to explain the no food/water to other family who will be trickling in tomorrow?
posted by yesster to Health & Fitness (18 answers total) 5 users marked this as a favorite
 
I believe 14 days was what hospice told us for my grandmother. She did not last that long. I'm sorry you're having to go through this.
posted by cecic at 10:23 PM on September 4, 2010


> Also, any advise for how to explain the no food/water to other family who will be trickling in tomorrow?

I recently went through this as well. I was just straightforward and calm with people, and made sure to make lots of eye contact. I kept the message simple: grandma is in palliative care and they're just going to do enough to make sure she is comfortable as she slips away. You'll have to find your own voice for that for it to be sincere, but others will respond soft honesty rather than beating around the bush about death.

Also, you really can't prepare for how you're going to feel once she's gone because that will never be like how you projected it might be like. Just stay in the present moment and close to your physical surroundings as much as possible. It's no small blessing to be able to say goodbye in person, though. I hope it's easy for you.
posted by Burhanistan at 10:42 PM on September 4, 2010 [1 favorite]


I went though this with my Grandpa a few years ago. Of course I know the survival rule of threes, the relevant ones being 3 days without water or three weeks without food. After three days there was a noticeable downturn, and after four it was certain to happen soon. The early AM of the 5th day was the end.

Sorry
posted by sanka at 10:47 PM on September 4, 2010


The things to emphasize are that she's not in pain, she's not hungry and she's not thirsty. When you're really sick and not eating it's not cause you're hungry and can't, it's cause you don't feel the hunger - same thing here.
posted by Silentgoldfish at 10:55 PM on September 4, 2010 [1 favorite]


Yesster:

I am incredibly sad for your position right now. I went throught the exact same thing.

My father was in a nursing home, and was prone to "little strokes". which meant he got sent off to the local hospital, and basically uprooted from everything he knew for a few hours, as long las it took the doctors to say there wasnt anything wrong with him.

So this happened again, and my sister, who was sort of the one closest said "God this has happened again, what should I do?"

I told her damn you know, we have been through this over and over, and all that happens is he comes back a little disoriented and pissed, give it a few minutes.

Well she called back literally five minutes later crying. "Oh my god, he had a big one, he had a big one!" It was about an hour and a half away, but I was in my car before my sister knew I had even dropped the phone.

It was a massive stroke, and my Dad knew as much, He refused any food or water for three days. I got him to take one sip of water, but that was about it. He was done.

In the many times I snuck out for a smoke, or a pull off my flask, I would talk to the nurses, and well, god bless em for minimum wage nursinjg home staff they are what they are, just said, "Could be three days, could be three weeks, I've seen it all."

I went back in the room, and crawled into bed with my father. I was 39. I whispered in his ear.

"I know what you're doing old man, and it's OK. You remember in 1970, when you made me go take the garbage out on my birthday and I was pissed? I didnt know you had spent money we didnt have to get me that bicycle I had been wishin on from the Sears catalog, and it was waiting next to the garbage cans for me."

"You know when Mom would get way drunk and call you names? I never forget the way you just used to shrug it off, and hold her hand every time the local AM station would play the Anniversary Waltz."

I just laid there holding him in my arms.

"It's OK Pops" I said. "Mom will be there. Remember your dogs? Barney? Xerxes? They will be be there too. You remember your Mom and Dad, and your brothers, and sisters? Do you remember when you worked in the logging camps up in Wisconsin. All of your friends are gonna be there."

"It's OK Dad. It's time."

I laid there as long as I could. Then I got in the car and drove back to Chicago. Two hours after I got home, my sister called.
posted by timsteil at 10:58 PM on September 4, 2010 [97 favorites]


Silentgoldfish has it - you're doing everything to keep her comfortable, and pushing food and drink on her at this point would make her less comfortable.

I'm so sorry you're going through this, I lost my own grandmother just a month ago and it has not been easy. It is good that you're with her now, I imagine that might come to mean a lot to you in the weeks to come.
posted by donnagirl at 11:01 PM on September 4, 2010


My Dad lasted a couple of days after he stopped drinking anything.

If she's in hospice care, they're usually great about explaining the situation to people drifting in.
posted by HopperFan at 11:06 PM on September 4, 2010


Thanks all. I want to hold her but she is so frail and fragile, and moving her seems to cause some pain. Just reading metafilter, listening to her breathing, stroking her head when she stirs.

My aunt had been here three days and nights solid. She.s now sleeping at a hotel, and other family will be here tomorrow.

I tried to explain to a sibling that it is an honor, something special to be here with grandma now.

Normally I'd be more verbose, but I'm on a phone with a chicklet keyboard, so again. thanks.
posted by yesster at 11:22 PM on September 4, 2010


My mom lasted almost 5 days after they began the no food/no water thing. It was easier to have the Hospice nurse explain why she didn't have food or water at the end because when you tell family members that mom isn't being given food or water anymore, they tend to freak out about it. It's very cool that you are getting to sit with someone at the end of their life. Most people tend to come into the world with lots of people around but leave it with few if anyone around so what you are doing is awesome!
posted by MsKim at 11:26 PM on September 4, 2010 [2 favorites]


I haven't been in the position you're in, but I just want to reinforce what silentgoldfish said. Someone I'm close to recently went through a version of no food/no water; she was badly undernourished, getting something like 10% of her calorie needs over a period of months and wasting away. It looked as if she wouldn't make it and family was called for last visits etc. (Long story how it happened in the first place. Luckily someone figured out the problem in time, upped her calories and she's ok now.)

Talking to her at the time, she did not feel hungry at all. Didn't want her favorite candies, didn't want salty crackers, didn't want a little water, didn't want to think about food or drink. She also was very peaceful and happy when she talked. This is a person (when healthier) who can be a bit negative, or dwell on things, and at this time there was none of that. She was uniformly positive about anything that was mentioned -- how much she was glad to see everyone, how nice and comfortable it was in her bed, etc. So her experience bears out what silentgoldfish said - in that extreme state, she was not uncomfortable at all and was in fact in a kind of calm and positive haze.
posted by LobsterMitten at 12:03 AM on September 5, 2010


3 days with no water?

If she isn't on a saline drip - say your goodbyes now. With saline ... about 3 weeks from her last decent meal.

My sympathies and hope that your grandma passes without pain.
posted by porpoise at 12:27 AM on September 5, 2010


So that "rule of 3" isn't all that accurate just to be clear. I've had patients last a week with no water and ages with no food. However, I generally tell families that a week is the longest to expect once the patient quits eating/drinking. No matter how long I work in hospice, I never stop being surprised at how individual the time-line for death can be. I do know that once a patient is actively dying, forcing food or fluids can make them very uncomfortable. The body just stops digesting. I'm so glad you are respecting the process, it makes me so sad (though I understand the reasons) when families force feed the dying, only to have them get diarrhea, vomiting, pain. Holding her may be uncomfortable for her, but knowing you are there and feeling the love and peace from the family is surely most comforting for her. I'm so sorry.
posted by yodelingisfun at 1:31 AM on September 5, 2010 [3 favorites]


My thoughts are with you as you do this last vigil; I've been there and it's rough. Feel free to pass them along to talk to the hospice nurses for info if you get tired repeating it, the end can be very quiet or very dramatic and there's really no way to tell. My mother went about a week without food but needed a lot of morphine. Most people, as others mentioned, are most concerned about comfort.

Strength to you and I hope her passing is easy.
posted by Wuggie Norple at 6:05 AM on September 5, 2010


My thoughts are with you. I am trying to remember how long it took with my father. He was under actual hospice care for a week or less, but I am trying to remember whether we stopped giving food and water in the hospice, or the hospital. It was a bit easier with him, because in his living will he specified that he did not want food or water if it was unnecessary and he was dying. No one questioned us about our decision, but we had a document that HE WROTE (with a lawyer) and HE SIGNED: these were HIS WISHES that we carried out! So I am a huge proponent of living wills.

But this is the key here: if family members are bothered, you may want to strongly note that the body naturdally rejects food or water when dying, and this is the kindest thing to do. Your grandmother would be less comfortable if she had to process this food and water, and you want to do the very, very kindest thing. You maybe should consider your wording here. Don't say something like "they [hospice staff] aren't giving her food and water," because that sounds like the staff made this decision, say "for Grandma's comfort, we [whoever "we" is] decided that stopping food or water was the kindest decision, since her body is no longer able to easily process it." Perhaps a nurse could help explain to them why this is more comfortable?

Big internet hug, yesster. You are a very good grandchild.
posted by teragram at 6:10 AM on September 5, 2010


My thoughts are with you.

Last January we experienced the same type of event with my wife's grandmother. I posted about it a while back. There might be some points of reference for you in that thread.
posted by HuronBob at 6:36 AM on September 5, 2010


For both my mother and my mother-in-law, who died in hospice, what I remember about the end is that they were both just mostly sleeping. I am not sure how much awareness was there at the end, but there was family around for both. It was only a few days after no food/water. As long as there are pain meds, apparently it's not traumatic. No thirst, no hunger. With my mother, I very clearly remember her breathing slowing down. She was very still and was breathing regularly, but spaced far apart. Then the breaths were farther and farther apart, and then one breath was the last. I too was honoured to be there so see her go; she brought me into the world, and I was there to say good-bye when she left the world. A death in palliative care seems to be very quiet and very calm.

The body is shutting down. It doesn't want food or water. It doesn't need them.

The person in that body, I am sure, is aware that they are surrounded by their loved ones. That has to be comforting.

Best wishes to you. It's rough, no matter the age of the person dying.

And also, this may not be the right place for it, but the nurses in hospice? THEY ROCK.
posted by Savannah at 7:41 AM on September 5, 2010


I am really sorry that you are going through this.

I'd like to reiterate that the rule of threes are not accurate. My grandmother chose to stop eating and drinking, and my family decided to respect her wishes. It was very difficult, and it lasted far longer than anyone thought it would. Even without a saline drip, she lived 6 days with no water.

It's wonderful that you are staying with her - it's not easy to watch this happen, and not everyone is up for the experience.
posted by scrute at 8:38 AM on September 5, 2010


Well, grandma left us peacefully on Sunday. That was a bit less than 5 days into the no food or water phase.

Thank you all for your support and stories.

One of the nurses had a nice informational sheet about "analgesic dehydration" which helped explain the process to family. This article covers it objectively, it seems.

Thanks all. Sorry for the delay in responding. This is my first access to a real keyboard.
posted by yesster at 6:01 AM on September 8, 2010 [1 favorite]


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